Joint Injections
- Intra-articular (Joint) corticosteroid injections are often used to control active arthritis in Juvenile Idiopathic Arthritis (JIA) - during disease flares or as 'bridging agents' to allow time for other therapies such as methotrexate (MTX) to be effective.
- Informed consent / assent must be recorded in the patient case notes.
- Joint injections are usually done as a day case and performed by individuals with appropriate training. In some centres nurses and physical therapists perform joint injections.
- Analgesia is very important:
- General anaesthetic for multiple joints or in younger children or to reach certain joints (e.g., hip, temporomandibular, subtalar joint).
- Inhaled nitrous oxide (Entonox®) is useful in older children and for up to 4 larger joints.
- Ethyl chloride topical spray is useful as topical skin anaesthesia.
- Sedation is not recommended — general anaesthetic is a much safer option.
- Triamcinolone hexacetonide is the drug of choice with the dose determined by body size and which joints are to be injected.
- Complications are uncommon with good technique - these include:
- Transient increases in blood pressure although increase in appetite and weight gain are rare (and usually if multiple joints are injected).
- Subcutaneous atrophy - most likely with joints with small intra-articular volume such as fingers, wrists, & subtalar joints.
- Sepsis - very small risk (<1in10,000 with good aseptic technique).
- Injected joints should be rested for 24h if possible but patients can be discharged home.
- Vigorous exercise and contact sports are not recommended for at least 48 hours.
- Instructions to seek health care are important (e.g., fever, hot joint, increase in pain).
- Nurses help explain the process and support patients and families on the day of the procedure.
- Nurses often administer the inhaled nitrous oxide (Entonox®) and prepare the patient for theatre.
